Individual
MS. MARY L. MELTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
463 ERNEST BILES DR., JACKSON, GA 30233
(770) 358-8326
(770) 775-1154
Mailing address
3 ELM STREET, COVINGTON, GA 30014-3353
(678) 342-2170
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN036141
GA
Other
Enumeration date
10/27/2010
Last updated
10/27/2010
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